Integrating Integrating Complementary and Complementary and Alternative Medicine Alternative Medicine into a Chiropractic into a Chiropractic

PracticePractice

Geoff Lecovin, D.C., N.D., L.Ac., Geoff Lecovin, D.C., N.D., L.Ac., CSCSCSCS

Education/TrainingEducation/Training

BS Human Biology (1989 LACC)BS Human Biology (1989 LACC) DC (1990 LACC)DC (1990 LACC) MS Nutrition (1992 University of MS Nutrition (1992 University of

Bridgeport)Bridgeport) MS Acupuncture (1994 Bastyr MS Acupuncture (1994 Bastyr

University)University) ND (1994 Bastyr University)ND (1994 Bastyr University) CSCS (2006 NSCA)CSCS (2006 NSCA) CES/PES (2007 NASM)CES/PES (2007 NASM)

What is CAM?What is CAM?

Complementary and Alternative Complementary and Alternative therapies that have been shown to therapies that have been shown to

be safe and effective.be safe and effective.

(NIH)(NIH)

e.g. e.g. naturopathic medicine, naturopathic medicine, acupuncture, manipulation,acupuncture, manipulation, guided guided

imagery, supplementationimagery, supplementation

Naturopathic Naturopathic MedicineMedicine

Naturopathic MedicineNaturopathic Medicine

Four-year graduate level Four-year graduate level naturopathic medical school naturopathic medical school

Holistic and nontoxic Holistic and nontoxic approaches emphasizing approaches emphasizing prevention and wellnessprevention and wellness

Professional board exams to Professional board exams to be licensed as a primary care be licensed as a primary care general practice physician general practice physician

Philosophy of Naturopathic Philosophy of Naturopathic MedicineMedicine

1.1. Do no harmDo no harm

2.2. Find the causeFind the cause

3.3. Treat the whole personTreat the whole person

4.4. The healing power of natureThe healing power of nature

5.5. PreventionPrevention

Scope of Practice (WA)Scope of Practice (WA)

Nutrition and food scienceNutrition and food science SupplementsSupplements Physical modalities/manual therapyPhysical modalities/manual therapy Minor office procedures Minor office procedures HomeopathyHomeopathy Botanical medicines/nutritional supplementsBotanical medicines/nutritional supplements Hygiene and immunizationHygiene and immunization Contraceptive devices Contraceptive devices Common diagnostic proceduresCommon diagnostic procedures Counseling and hypnosisCounseling and hypnosis Intramuscular and intravenous therapiesIntramuscular and intravenous therapies Prescription drugs (all legend/limited controlled Prescription drugs (all legend/limited controlled

substances)substances) Diagnostic procedures (e.g. lab, imaging, etc.)Diagnostic procedures (e.g. lab, imaging, etc.)

Naturopathic Patient Naturopathic Patient DemographicsDemographics

Pain/sports injuries/auto & work injuriesPain/sports injuries/auto & work injuries Family practiceFamily practice Obesity Obesity Cardiovascular Cardiovascular

disease/hypertension/diabetesdisease/hypertension/diabetes WellnessWellness NHRT, depression, ADD/ADHD, NHRT, depression, ADD/ADHD,

women’s/men’s health, pediatrics, oncology, women’s/men’s health, pediatrics, oncology, fertilityfertility

Naturopathic physicians are Naturopathic physicians are

currently licensed in these statescurrently licensed in these states::

Alaska Alaska Arizona Arizona California California Connecticut Connecticut District of Columbia District of Columbia Hawaii Hawaii Kansas Kansas Maine Maine Montana Montana New Hampshire New Hampshire Oregon Oregon Utah Utah Vermont Vermont Washington Washington US Territories: Puerto Rico and Virgin Islands US Territories: Puerto Rico and Virgin Islands

AcupunctureAcupuncture

AcupunctureAcupuncture

Traditional Chinese Medicine (TCM)Traditional Chinese Medicine (TCM) Neuro-anatomic acupuncture (“dry Neuro-anatomic acupuncture (“dry

needling”)needling”)

TCMTCM

The practice of acupuncture dates The practice of acupuncture dates back nearly 5000 years, where it back nearly 5000 years, where it began in China and other Asian began in China and other Asian countries. countries.

Over the course of its development, Over the course of its development, ancient practitioners developed ancient practitioners developed concepts and systems reflecting the concepts and systems reflecting the religious, medical and cultural religious, medical and cultural beliefs of their time. beliefs of their time.

Neuro-Anatomic Explanations Neuro-Anatomic Explanations for Acupuncturefor Acupuncture

Lesions created by inserting sterile needles in the Lesions created by inserting sterile needles in the soft tissue activate the bodysoft tissue activate the body’’s main systems: s main systems:

NervousNervous Cardiovascular Cardiovascular EndocrineEndocrine Immune Immune

This promotes homeostasis and stimulates healing.This promotes homeostasis and stimulates healing. ((Yun-tao Ma, Mila Ma, Zang  Hee Cho, Yun-tao Ma, Mila Ma, Zang  Hee Cho, Biomedical Biomedical

AcupunctureAcupuncture))

Effects of Dry NeedlingEffects of Dry Needling

1.1. Strengthen tendons & ligaments by Strengthen tendons & ligaments by inducing local inflammatory reactions inducing local inflammatory reactions

2.2. Stimulates GTO & muscle spindles inducing Stimulates GTO & muscle spindles inducing muscle relaxationmuscle relaxation

3.3. Mechanically disrupts trigger pointsMechanically disrupts trigger points4.4. Treats overactive motor pointsTreats overactive motor points5.5. Provides blood & growth factors, which can Provides blood & growth factors, which can

increase circulation, disrupt micro-scars increase circulation, disrupt micro-scars and repair tissueand repair tissue

6.6. Alters neural control via neurotransmittersAlters neural control via neurotransmitters7.7. Stimulates neural reflex mechanismsStimulates neural reflex mechanisms

Chiropractic, Chiropractic, Manual Therapies Manual Therapies

and Exerciseand Exercise

Beyond chiropractic help Beyond chiropractic help

Kinetic ChainKinetic Chain

Kinetic Chain

Muscular Articular Neural

Muscle Imbalance/Joint dysfunction

(upper & lower crossed syndromes)

Altered reciprocal inhibitionAltered reciprocal inhibition

Synergistic dominanceSynergistic dominance

Myofascial dysfunctionMyofascial dysfunction

Arthrokinetic dysfunctionArthrokinetic dysfunction

Manual TherapyManual Therapy Spinal and extremity manipulationSpinal and extremity manipulation Mulligan techniquesMulligan techniques Soft tissue manipulation Soft tissue manipulation

-NMR-NMR-Soft tissue release-Soft tissue release-Gua Sha -Gua Sha -Active isolated stretching-Active isolated stretching

ModalitiesModalities ExerciseExercise

Corrective Exercise Corrective Exercise ProtocolProtocol(NASM)(NASM)

InhibitInhibit- self myofascial release - self myofascial release with foam rollerswith foam rollers

LengthenLengthen- stretching- stretching ActivateActivate- isolated intramuscular - isolated intramuscular

strengtheningstrengthening IntegrateIntegrate- full body intermuscular - full body intermuscular

movementsmovements

NASM Exercise ModelNASM Exercise Model

Case Study:Case Study:An Integrative An Integrative

ApproachApproach

Triad of HealthTriad of Health

Structural

Psychological Biochemical

HistoryHistory 28 y/o female Caucasian presents with 28 y/o female Caucasian presents with

headaches 3-5x/wk that started during headaches 3-5x/wk that started during high school and have progressively high school and have progressively worsened. They are 3-6/10 (10 being worsened. They are 3-6/10 (10 being worst). Massage, chiropractic and heat worst). Massage, chiropractic and heat are temporarily palliative. Stress and are temporarily palliative. Stress and working on the computer are provocative. working on the computer are provocative. History of minor rear-end collision in high History of minor rear-end collision in high school. Symptoms worsen during menses. school. Symptoms worsen during menses. Other complaints include low energy and Other complaints include low energy and difficulty losing weight.difficulty losing weight.

Review of SystemsReview of Systems General – NAD, A&O x 3, overweightGeneral – NAD, A&O x 3, overweight EENT, cardiovascular, respiratory, EENT, cardiovascular, respiratory,

gastrointestinal, genitourinary and gastrointestinal, genitourinary and neurological are unremarkableneurological are unremarkable

Musculoskeletal - neck pain & headachesMusculoskeletal - neck pain & headaches Skin - eczemaSkin - eczema Psychiatric - high stress jobPsychiatric - high stress job Endocrine - heavy mensesEndocrine - heavy menses Hematologic - history of anemiaHematologic - history of anemia Allergy/immunologic - seasonal allergiesAllergy/immunologic - seasonal allergies

PMhx/Family hx/Social PMhx/Family hx/Social hxhx

PMhx - unremarkablePMhx - unremarkable Family hx - mother has hypothyroidismFamily hx - mother has hypothyroidism Social hx - single; non-smoker; light Social hx - single; non-smoker; light

drinkerdrinker Occupation - Microsoft software engineerOccupation - Microsoft software engineer Sleep – poor (5-6 hrs interrupted)Sleep – poor (5-6 hrs interrupted) Exercise – occasional yogaExercise – occasional yoga Diet - high refined carbohydrate/fast Diet - high refined carbohydrate/fast

foods; often skips breakfast and/or lunchfoods; often skips breakfast and/or lunch

Examination/Diagnostic Examination/Diagnostic TestingTesting

Vitals (Ht 5’4”; Wt 137 lb; BP 90/68; P 77Vitals (Ht 5’4”; Wt 137 lb; BP 90/68; P 77 Eyes - 20/20 visionEyes - 20/20 vision Head and neck - normocephaly. No Head and neck - normocephaly. No

thyromegaly.thyromegaly. ENT - tender frontal and maxillary sinusesENT - tender frontal and maxillary sinuses Cardio/Pulm/Abdomen - unremarkableCardio/Pulm/Abdomen - unremarkable Skin - dry Skin - dry Cervical X-ray – loss of cervical lordosisCervical X-ray – loss of cervical lordosis Blood work - TSH 5.3; D3 22; Ferritin 20Blood work - TSH 5.3; D3 22; Ferritin 20

- CBC and Chem within normal - CBC and Chem within normal limitslimits

AssessmentAssessment

Chronic tension headachesChronic tension headaches HypothyroidHypothyroid OverweightOverweight Iron deficiencyIron deficiency Vitamin D deficiencyVitamin D deficiency InsomniaInsomnia

Naturopathic TreatmentNaturopathic Treatment

Dietary modificationDietary modification Supplement prescriptionSupplement prescription Armour thyroidArmour thyroid Systematic relaxation/guided Systematic relaxation/guided

imagery/breathing home exercisesimagery/breathing home exercises

A Balanced Approach to A Balanced Approach to DietDiet

Focus on fueling the body with nutrient dense, anti-Focus on fueling the body with nutrient dense, anti-inflammatory foods that satisfy energy requirementsinflammatory foods that satisfy energy requirements

Optimize nutrients Optimize nutrients Shift balance of omega-3:omega-6 fatsShift balance of omega-3:omega-6 fats Change carbohydrate sources to fruits and vegetables (low Change carbohydrate sources to fruits and vegetables (low

glycemic load)glycemic load) Incorporate lean protein sources with every meal and Incorporate lean protein sources with every meal and

snacksnack Increase phytonutrients and waterIncrease phytonutrients and water

(In other cases, it might be indicated to identify (In other cases, it might be indicated to identify potential food sensitivities through food potential food sensitivities through food

elimination/challenge)elimination/challenge)

Healthy PlateHealthy Plate

Protein

Starch

Non-starchy veggies

CornPeasPotatoesPumpkinSquashSweet potatoesYams(Brown/wild rice, oats, Quinoa)

Beans & lentilsBeef (grass fed)Poultry (w/o skin)Dairy (Yogurt)EggsFishNuts & nut butters

BroccoliCabbageCarrotsCauliflowerDark green leafy veggies (e.g. Spinach, kale, chard, Brussels sprouts etc.)Green beansPeppersTomatoes

+ healthy fats, including:AvocadoNuts and seedsOlive & Canola oil

The Power of ColorThe Power of ColorREDRED ((anthocyanins, lycopenesanthocyanins, lycopenes) - strawberries, cranberries, ) - strawberries, cranberries,

raspberries, cherries, grapes, beets, peppers, water melon, raspberries, cherries, grapes, beets, peppers, water melon, pomegranates, apples, onions, pink grapefruitpomegranates, apples, onions, pink grapefruit

ORANGE-YELLOWORANGE-YELLOW ((beta carotene, lutein, zeaxanthinbeta carotene, lutein, zeaxanthin) - carrots, ) - carrots, sweet potatoes, yellow potatoes, orange, mangoes, cantaloupe, sweet potatoes, yellow potatoes, orange, mangoes, cantaloupe, pumpkin, squash, apricots, corn, banana, turmeric, gingerpumpkin, squash, apricots, corn, banana, turmeric, ginger

GREENGREEN ((beta carotene, luteinbeta carotene, lutein)- spinach, chard, kale, avocado, )- spinach, chard, kale, avocado, asparagus, artichokes, broccoli. Brussels sprouts, cabbage, green teaasparagus, artichokes, broccoli. Brussels sprouts, cabbage, green tea

BLUE-PURPLEBLUE-PURPLE ( (anthocyaninsanthocyanins)- blueberries, blackberries, grapes, red )- blueberries, blackberries, grapes, red wine, eggplantwine, eggplant

WHITEWHITE- garlic, onion, cauliflower- garlic, onion, cauliflower

BLACK/BROWNBLACK/BROWN- - Coffee, dark chocolate, nuts, stout beerCoffee, dark chocolate, nuts, stout beer

The Color CodeThe Color Code. James A. Joseph, Ph.D., Daniel A. Nadeau, M.D., Anne . James A. Joseph, Ph.D., Daniel A. Nadeau, M.D., Anne UnderwoodUnderwood

Supplements Supplements (Thorne)/Prescriptions(Thorne)/Prescriptions

Multiple with iron Multiple with iron Iron - 20 mg qdIron - 20 mg qd Vitamin D - 2000 IU qdVitamin D - 2000 IU qd Fish oil (Nordic Naturals) - 1000 mg tidFish oil (Nordic Naturals) - 1000 mg tid L-Tryptophan - 1000 mg at bed timeL-Tryptophan - 1000 mg at bed time Armour Thyroid (Rx) - 60 mg away from Armour Thyroid (Rx) - 60 mg away from

iron and multipleiron and multiple• TSH to be re-tested after 1 monthTSH to be re-tested after 1 month• Ferritin and D3 to be re-tested after 12 Ferritin and D3 to be re-tested after 12

weeksweeks

Acupuncture TreatmentAcupuncture Treatment

1. 1. Symptomatic points -Symptomatic points - local local trigger pointstrigger points

2. 2. Paravertebral points -Paravertebral points - cervical cervical and thoracicand thoracic

3. 3. Homeostatic points –Homeostatic points – facial, facial, upper upper extremity and shoulder extremity and shoulder region region

Chiropractic TreatmentChiropractic Treatment

Soft tissue release/NMR to address Soft tissue release/NMR to address shortened muscles (upper crossed shortened muscles (upper crossed syndrome)syndrome)

Spinal manipulation to Spinal manipulation to cervical/thoracic/lumbar areas of cervical/thoracic/lumbar areas of segmental dysfunctionsegmental dysfunction

Headache SNAGS (Mulligan)Headache SNAGS (Mulligan) Home corrective exercisesHome corrective exercises

Home Corrective Home Corrective ExercisesExercises

Self-myofascial releaseSelf-myofascial release with tennis with tennis balls and foam rollersballs and foam rollers

Static stretchesStatic stretches Isolated strengthening -Isolated strengthening - scaption, scaption,

deep neck flexorsdeep neck flexors Integrated movements -Integrated movements - squat to squat to

rowrow

OutcomeOutcome Patient was seen two times per week for one monthPatient was seen two times per week for one month Headache frequency was reduced to once per weekHeadache frequency was reduced to once per week Sleep, energy and feeling of wellbeing were Sleep, energy and feeling of wellbeing were

improvedimproved Skin hydration improvedSkin hydration improved TSH after one month decreased to 2.1 (thyroid Rx TSH after one month decreased to 2.1 (thyroid Rx

was refilled for 6 additional months)was refilled for 6 additional months) Frequency of visits reduced to once qo wk for four Frequency of visits reduced to once qo wk for four

more visits, at which time headaches were minimalmore visits, at which time headaches were minimal Exercise progressed from corrective to strength Exercise progressed from corrective to strength

training 2x/wk, + yoga 1-2 x/wktraining 2x/wk, + yoga 1-2 x/wk At 12 weeks, headaches were infrequent. Vitamin D At 12 weeks, headaches were infrequent. Vitamin D

level was 52 and Ferritin level was 68level was 52 and Ferritin level was 68 Next follow-up was scheduled for 3 months Next follow-up was scheduled for 3 months

Recommended ResourcesRecommended Resources Certifications: NASM - CES and PESCertifications: NASM - CES and PES Seminars:Seminars:

NMR training with Peter Levy, DCNMR training with Peter Levy, DC Mulligan techniqueMulligan technique Hands on Seminars – trigger point therapyHands on Seminars – trigger point therapy Gaby/Wright – medical nutritionGaby/Wright – medical nutrition Stuart Taws – soft tissue releaseStuart Taws – soft tissue release Stuart McGill, PhD (books and seminars)Stuart McGill, PhD (books and seminars)

Books:Books: Natural Hormonal EnhancementNatural Hormonal Enhancement – Rob Faigin – Rob Faigin Good Calorie, Bad CalorieGood Calorie, Bad Calorie – Gary Taubs – Gary Taubs The Gunn Approach to PainThe Gunn Approach to Pain – Chan Gunn – Chan Gunn Acupuncture, Trigger Points and Musculoskeletal PainAcupuncture, Trigger Points and Musculoskeletal Pain – Peter Baldry – Peter Baldry Trigger point manuals, Travell and Simons Trigger point manuals, Travell and Simons Biomedical Acupuncture, Biomedical Acupuncture, Yun-tao Ma, Mila Ma, Zang  Hee ChoYun-tao Ma, Mila Ma, Zang  Hee Cho New Rules of LiftingNew Rules of Lifting, Schuler and Cosgrove, Schuler and Cosgrove

Internet: www.vitasearch.com, www.nutraingredients.com Internet: www.vitasearch.com, www.nutraingredients.com

Dr. Geoff LecovinDr. Geoff Lecovin

Evergreen Integrative Evergreen Integrative MedicineMedicine

www.eimed.comwww.eimed.com

geofflecovin@hotmail.comgeofflecovin@hotmail.com